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Avatar therapy helps silence voices in schizophrenia

29 May 2013

An avatar system that enables people with schizophrenia to control the voice of their hallucinations is being developed by researchers at UCL with support from the Wellcome Trust.

The computer-based system could provide quick and effective therapy that is far more successful than current pharmaceutical treatments, helping to reduce the frequency and severity of episodes of schizophrenia.

In an early pilot of this approach involving 16 patients and up to seven 30-minute sessions of therapy, almost all of the patients reported a reduction in the frequency and severity of the voices that they hear. Three of the patients stopped hearing voices completely after experiencing them for 16, 13 and 3.5 years. The avatar therapy does not address the patients' delusions directly, but the study found that these do improve as an overall effect.

The team has now received a £1.3 million Translation Award from the Wellcome Trust to refine the system and conduct a larger, randomised study to evaluate this novel approach to schizophrenia therapy. The study will be conducted at King's College London Institute of Psychiatry.

The first stage in the therapy is for the patient to create a computer-based avatar, by choosing the face and voice of the entity they believe is talking to them. The system then synchronises the avatar's lips with its speech, enabling a therapist to speak to the patient through the avatar in real time. The therapist encourages the patient to oppose the voice and gradually teaches them to take control of their hallucinations.

Julian Leff, Emeritus Professor of Mental Health Sciences at UCL, who developed the therapy and is leading the project, said: "Even though patients interact with the avatar as though it was a real person, because they have created it they know that it cannot harm them, as opposed to the voices, which often threaten to kill or harm them and their family. As a result the therapy helps patients gain the confidence and courage to confront the avatar, and their persecutor.

"We record every therapy session on MP3 so that the patient essentially has a therapist in their pocket which they can listen to at any time when harassed by the voices. We've found that this helps them to recognise that the voices originate within their own mind and reinforces their control over the hallucinations."

The larger study will begin enrolling the first patients in early July. The team are currently training the therapists and research staff to deliver the avatar therapy and finalising the study set-up. The first results are expected towards the end of 2015.

Professor Thomas Craig of King's College London Institute of Psychiatry, who will lead the larger trial, said: "Auditory hallucinations are a very distressing experience that can be extremely difficult to treat successfully, blighting patients' lives for many years. I am delighted to be leading the group that will carry out a rigorous randomised study of this intriguing new therapy with 142 people who have experienced distressing voices for many years.

"The beauty of the therapy is its simplicity and brevity. Most other psychological therapies for these conditions are costly and take many months to deliver. If we show that this treatment is effective, we expect it could be widely available in the UK within just a couple of years as the basic technology is well developed and many mental health professionals already have the basic therapy skills that are needed to deliver it."

Schizophrenia affects around 1 in 100 people worldwide, the most common symptoms being delusions (false beliefs) and auditory hallucinations (hearing voices). The illness often has a devastating effect, making it impossible to work and to sustain social relationships. Even with the most effective anti-psychotic medication, around one in four people with schizophrenia continue to suffer from persecutory auditory hallucinations, severely impairing their ability to concentrate.

Current guidelines from the National Institute for Health and Care Excellence (NICE) recommend that schizophrenia is treated using a combination of medication and talking therapies, such as cognitive behavioural therapy. However, fewer than one in ten patients with schizophrenia in the UK have access to this kind of psychological therapy.

Ted Bianco, Director of Technology Transfer and Acting Director of the Wellcome Trust, said: "At a time when many companies have become wary about investing in drug discovery for mental health, we are delighted to be able to facilitate the evaluation of an alternative approach to treatment based on the fusion of a talking therapy with computer-assisted 'training'.

"In addition to the attraction that the intervention is not reliant on development of a new medication, the approach has the benefit of being directly testable in patients. Should the results of the trial prove encouraging, we expect there may be further applications of the basic strategy worth exploring in other areas of mental health."

The Wellcome Trust has funded this project through its translational funding programme, which helps turn early-stage innovations into new health products by supporting researchers to advance the innovation to the point where it becomes attractive for further development by the medical industry or healthcare agencies.

Paul Jenkins, CEO of the charity Rethink Mental Illness said: "We welcome any research which could improve the lives of people living with psychosis. As our Schizophrenia Commission reported last year, people with the illness are currently being let down by the limited treatments available. While antipsychotic medication is crucial for many people, it comes with some very severe side-effects. Our members would be extremely interested in the development of any alternative treatments."

Contact

Notes to Editors

People interested in finding out more about the randomised controlled trial at King's College London should email
avatar@kcl.ac.uk.

About schizophrenia

About one in 100 people will have one episode of schizophrenia in their lifetime and two thirds of these will go on to have further episodes [1].

Symptoms of schizophrenia usually begin in the late teens or early 20s, but can also begin later in life [1].

There are an estimated 220 000 people living in England with schizophrenia [2].

In England the cost to society is estimated at £11.8 billion per year (£60 000 per individual with schizophrenia), with the public sector cost being £7.2 billion per year (£36 000 per individual with schizophrenia) [2].

Only 8 per cent of people with schizophrenia are in employment, yet many more could and would like to work [2].

People with severe mental illness such as schizophrenia still die 15-20 years earlier than other people [2].

About the Wellcome Trust
The
Wellcome Trust is a global charitable foundation dedicated to achieving extraordinary improvements in human and animal health. It supports the brightest minds in biomedical research and the medical humanities. The Trust's breadth of support includes public engagement, education and the application of research to improve health. It is independent of both political and commercial interests.

About UCL (University College London)
Founded in 1826,
UCL was the first English university established after Oxford and Cambridge, the first to admit students regardless of race, class, religion or gender and the first to provide systematic teaching of law, architecture and medicine.

It is among the world's top universities, as reflected by ts performance in a range of international rankings and tables. According to the Thomson Scientific Citation Index, UCL is the second most highly cited European university and the 15th most highly cited in the world.

UCL has nearly 25,000 students from 150 countries and more than 9,000 employees, of whom one third are from outside the UK. The university is based in Bloomsbury in the heart of London, but also has two international campuses – UCL Australia and UCL Qatar. Our annual income is more than £800 million.

About King's College London’
is one of the top 30 universities in the world (2012/13 QS international world rankings), and was The Sunday Times 'University of the Year 2010/11', and the fourth oldest in England. A research-led university based in the heart of London, King's has more than 25,000 students (of whom more than 10,000 are graduate students) from nearly 140 countries, and more than 6,500 employees. King's is in the second phase of a £1 billion redevelopment programme which is transforming its estate.

King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of the academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £525 million (year ending 31 July 2011).

King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar.

King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of ’
King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services.

The College is in the midst of a five-year, £500 million fundraising campaign -
World questions|King’s answers - created to address some of the most pressing challenges facing humanity as quickly as feasible. The campaign's five priority areas are neuroscience and mental health, leadership and society, cancer, global power and children's health.